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Langara college

LANGARA COLLEGE
NURSING DEPARTMENT
N2140 COURSE OUTLINE
NURSING PRACTICE 3
AUTHOR/FACILITATOR: Sharon Stunder, RN MN (SEC 1)
FACILITATOR: TBA (SEC 2)
COURSE OUTLINE

Nursing Practice 111 is an in classroom ‘experiential’ course designed to assist
participants in integrating theory with practice in the clinical setting in the context
of caring relationships.
ENDS IN VIEW

Continued development in the role of the professional nurse is the anticipated
outcome through guidance applying theory to practice, using select prototypes
and practice exemplars. Participants will further develop in integrating relevant
empirical sciences, social sciences, and nursing skills and abilities leading to
increased independence in decision-making. Attention to safety, competent skills
performance (including assessment) and decision-making with contextual
awareness are emphasized.

PROCESS

A workshop approach is used for developing a conceptual and experiential
understanding of professional nursing practice. Students need to come prepared
for class having done assigned readings from the texts. Participants are
encouraged to bring relevant clinical practice examples for discussion,
exploration and integration with class content. Critical thinking, critical reflection
and exploring the roles of the nurse in health promotion and healing are
encouraged. Active participation in discussions, small group activities, case-
studies, role-play, pair work and individual study are some of the teaching and
learning approaches. Demonstrations and lectures are also used when
considered appropriate.
Resources may include:
-Nursing practice settings (clinical) -Nursing practice labs/NERC -Selected textbooks, readings and other materials -Selected community resources -Selected clients (individuals, families, groups, communities) -Peer and other groups -Case-studies -Professional practice requirements Evaluation may be based on: -Written reports (case study analysis, decision-making) -In class short answer questionnaires -Multiple choice tests -Reflective journals -Attendance -Practice Appraisal Form
-Clinical Practice Guidelines
-Satisfactory/Unsatisfactory grading
OVERVIEW
Learning in this course is based on integrating knowledge from previous learning,
other Term 3 courses, and practice experiences with clients experiencing
episodic and common predictable health challenges. Content integrated into this
course includes but is not limited to the following:
-empirical sciences (pathophysiology, pharmacology, lab values)
-social sciences
-critical
-relationships (clients, colleagues, multidisciplinary team)
-legalities (underpinnings supporting practice, documentation)
CONCEPTS

Current and previously learned concepts of the curriculum will be explored and
may include the following:
-Transition/change

MINIMAL SEMESTER REQUIREMENTS

Students need to receive a Satisfactory standing in all classroom and clinical
evaluations, including consistent satisfactory performance in N2140 both in the
classroom and in clinical to obtain a Satisfactory standing for the course.
ATTENDANCE
It is anticipated attendance will correlate with learning outcomes. Arriving on time
and not disrupting a class in progress is an expected courtesy of all students. As

a courtesy to the Facilitator, please notify the Facilitator by email at
in advance of any absenteeism from the class. Copies
of handouts for the missed class will be set a side for students when prior
notification is made along with a request for the handouts. Attendance on all
clinical practice days is expected. Absenteeism from clinical requires a
physician’s note for each clinical absence. Being absent from clinical may affect
forward progression in the term due to not meeting required practice hours and
the consequent inability of the Clinical Facilitator to adequately observe and
evaluate performance ability.
RESOURCES MAY INCLUDE

-Laboratory and nursing practice settings
-Self directed nursing lab
-N2140 Course Outline
-Selected readings
-Program texts
-Website links
-Simulations
-Practice experience examples

The classroom Facilitator for this course is Sharon Stunder, RN, BScN, MN
Contact information includes: PH 604-323-5756 and Email
. Office hours are on Thursday from 1230-1630 hrs and
on Friday from 1630-1730 hrs.
REQUIRED TEXTS

All texts for this course were required for purchase in previous terms

Anderson, K.N., (2006). Mosby’s Medical, Nursing and Health Professions
Dictionary. (7th ed.). St Louis: Elsevier Mosby. Brophy, K.M., Scarlett-Ferguson, H. & Webber, K.S. (2008). Clinical drug therapy for Canadian practice. (1st Can. Ed.). Philadelphia: Lippincott. Buchholz, S. (2006). Henke’s Med Math: Calculation, Preparation and Administration (5th ed.). Philadelphia: Lippincott. Deglin, J.H. & Vallerand, A.H. (2007). Davis’s drug guide (10th ed.). Philadelphia: F.A. Davis.
Langara College Nursing Department (2006). Langara College Nursing
Department
Student Policies and Procedures. Vancouver, BC: Author.
Lewis, S.M., Heitkemper, M., & Dirksen, S. (2006). Medical-Surgical nursing in
Canada: Assessment and management of clinical problems (with CD) (1st
Canadian ed.), Toronto: Elsevier Mosby.
Pagana, K., & Pagana, T. (2007). Mosby’s diagnostic & laboratory test reference
(8th ed.). St. Louis: Elsevier Mosby.
Potter, P., Perry, A., Ross-Kerr, J. & Wood, M. (2006). Canadian Fundamentals
of Nursing (3rd ed), (with CD). Toronto: Elsevier Mosby.


EVALUATION

Nursing Practice 3 is comprised of two parts including Classroom and Practice
(Clinical). Participants are required to achieve a satisfactory standing in each part
to achieve a Satisfactory, overall, for Nursing Practice 3.
Grade assignment for Nursing Practice 3 is either “S” for Satisfactory or “U” for
Unsatisfactory.
Satisfactory for Nursing Practice 3 requires achieving an average grade of 60% overall for the three classroom evaluations. 1) The Multiple choice exam worth 30% is held in Week 4 and is based on all materials from Week 1 through Week 3 inclusive 2) The Multiple choice and short answer exam worth 35% is held in Week 9 and is based on all materials from Week 5 through Week 8 inclusive 3) The Multiple choice exam worth 35% is held during the Final Exam Period and is based on all materials from Week 10-13 inclusive All examinations are to be written at the scheduled date and time. In extenuating circumstances only, and whenever possible prior to the examination, notifying the Facilitator of the absence from the exam, both by phone and by email is requested with an explanation for the cause of the absence. A physician’s note
for each absence is required. A short notice absence requires a physician’s note
dated on the day of the exam or the day following. Each case of absenteeism
from an exam will be reviewed on an individual basis in consultation with the
Term 3 Team and the Chair of the Nursing Dept with a copy of the physician’s
note kept on the student’s file.
Students need to receive a satisfactory standing in all clinical evaluations
including their actual practice ability for successful completion of Nursing Practice
3. The clinical assignments include: 1) two case studies of clients using the
Decision-making for Nursing Practice Framework (Jan 2008) (DMFNPF); 2) two
Clinical Practice Analyses (CPA’s) with one CPA due prior to midterm and the
other CPA due prior to the end of clinical practice; and 3) a group poster
highlighting optimal practice based on research on an area of interest pertaining
to the clinical rotation.
Students are expected to attend all clinical practice days to achieve a “S” grade
in clinical. If an absence is unavoidable, students in practice must notify the
appropriate nurse educator and agency regarding their absence as early as
possible and before the scheduled experience. Telephone notification is required
for each absent day. Please refer to the Langara College Nursing Department
Student Policies and Procedures relative to absences.
It is expected that students attend all of the practice experience orientation. Non-
attendance for part or all of orientation to the practice setting will be documented
on the student’s Performance Appraisal Form. Students should understand that
absence from orientation or prolonged or frequent absences from the practice
area may negatively affect their ability to satisfactorily achieve the competencies
outlined in the Practice Appraisal Form.
Participants must maintain a “C” grade minimum in all courses in the Nursing Program with an overall grade of 60% to progress in the Program. Participants must achieve a grade of 60% in Nursing Practice 3 in order to
achieve a “S” grade for the classroom portion of Nursing Practice 3.

Participants are asked to read and adhere to the current “Langara College
Nursing Department Student Policies and Procedures” manual and to the policies
of the clinical agency where they engage in practice. Participants who engage in
unsafe behaviour, unsafe clinical judgement, or who do not abide by professional
practice standards will not be permitted to continue in the practice/clinical setting
resulting in a “U” grade for practice/clinical and, consequently, in Nursing
Practice 3.
ASSIGNMENTS

CLINCIAL ASSIGNMENTS
The DMFNPF (Jan 2008) is used as a format to present the case-study of a
client the student provided care for during the practice experience. Two
DMFNPF assignments need to be completed. Students answer all questions
posed on the DMFNPF regarding the client. Integration of nursing care,
interpretation of lab values and medications is highlighted for learning. Students
need to complete three priority clinical impressions based on physical challenges
and two priority psychosocial clinical impressions for the client.
The DMFNPF assignments are to be done individually and are to be submitted to
the Clinical Facilitator in Week 5 of the term and Week 12 of the term
respectively. DMFNPF assignments that are incomplete or unsatisfactory may
be re-submitted to the Clinical Facilitator for re-marking in the following week
after the due dates above.
The CPA’s are to be based on thoughtful reflection and critical thinking of events
that took place during clinical learning and should compare real-life practice with
theoretical learning. The importance of the event and conclusions drawn by the
student should show evidence of integration and internalization of nursing values
and striving for an optimal level of nursing standards of practice for self.
The poster integrates the research thread through the curriculum as it applies to
clinical practice. Students choose an area of interest from clinical practice,
construct a poster highlighting optimal practice in the area, with research to
substantiate the practice, and present the poster to the unit. Poster presentations
are to take no more than 10 minutes to the unit staff.
Midterm and Final evaluations are completed during Week 7 and Week 14 by
individual appointment at a scheduled time at the College. Students are to complete their own self-evaluation using the Performance Appraisal Form (PAF) for Term 3 provided by the Clinical Facilitator at the commencement of the term. Students are to record examples of how they have met the Competencies, as guided by the Quality indicators, as well as complete a rating of their own performance. Students need to have a rating of “Satisfactory-Average Performance” in each Domain for each Competency as rated by self as well as by the Clinical Facilitator by the end of term to be successful in Nursing Practice 3. Clinical Facilitators are responsible for summarizing the student’s progress in writing with a notation of whether the student is Satisfactory or Unsatisfactory for each Domain of learning, both at the Midterm evaluation and the Final evaluation. Both student and Clinical Facilitator are to sign and date all documentation at Midterm and Final evaluations. LAB VALUES
Lab values that you need to know each week are listed on the Course Schedule.
PHARMACOLOGY TEMPLATE
The Langara College Nursing Department Pharmacology Template is a
structured format to assist students in learning important information and
answering questions related to the medications associated with each health
challenge/prototype in this course.
Please complete the Pharmacology Template each week prior to class for each
medication that is listed in the Course Schedule. Information on medications is
examinable on the in class quizzes and on the scheduled examinations. See
Appendix for the DMFNPF (Jan 2008) and the Pharmacology Template.
DECISION-MAKING FOR NURSING PRACTICE FRAMEWORK (Jan 2008)
(DMFNPF)
The DMFNPF (Jan 2008) has a client centered caring focus and guides the
nurse in assessment, analysis, clinical impressions, nursing actions and
evaluation. The DMFNPF (Jan 2008) is integral to this course and will guide
learning of each health challenge/prototype). See Appendix.
COURSE SCHEDULE
-Course Overview, Assessment (Gordon’s, Head-to-toe, Medical Model (body systems)) and Decision-making, Decision-making for Nursing Practice Framework, Documentation, Safety in Medication Administration WEEK 2
-Asthma
-Oxygen Initiation & Maintenance, Pulse Oximetry (SpO2)
-Arterial Blood Gas (ABG)
-Nebulizer therapy:
*beta2-agonists eg. salbutamol (Ventolin); albuterol (Proventil)
*anticholinergics eg. ipratropium bromide (Atrovent)
*corticosteroids eg. beclomethasone (Beclovent); budesonide (Pulmicort);
methylprednisolone (Solu-Medrol) IV
-Metered Dose Inhalers (MDI)
-Peak (Expiratory) Flow Meter and Graph
-“Plan of Action” -Lab Values: -ABG -White -Anxiety
-Control

WEEK 3
-Chronic Obstructive Pulmonary Disease (COPD)
-Oxygen Initiation & Maintenance, Pulse Oximetry (SpO2) -Arterial Blood Gas Analysis (ABG) *Nebulizer therapy & inhalation bronchodilators: Ventolin; Atrovent; and Pulmicort *corticosteroids eg. oral Prednisone; methylprednisolone (Solu-Medrol) -Lab Values: -Arterial Blood Gas (ABG) -Complete Blood Count (CBC) -Red Blood Cell Count (RBC) -Hemoglobin (Hb or Hgb) -Hematocrit (Hct) -White Blood Cell Count (WBC) -White Blood Cell differential: -lymphocytes -mononcytes -neutrophils -basophils -eosinophils
WEEK 5
-Pneumonia
-Oxygen Initiation & Maintenance, SpO2, & ABG
-Oxygen titration
-Weaning (from) Oxygen
-Fever & Dehydration
-Fluid balance
*Anti-infectives: – *penicillins eg. Amoxicillin; *cephalosporins; ceftriaxone
(Rocephin); *miscellaneous eg. Vancomycin *aminoglycosides eg. Gentamycin
(gentamicin)
-Gentamycin levels or serum gentamicin levels -Vancomycin levels or serum vancomycin levels -Lab Values: -Sodium (Na+) -Potassium (K+) -Chloride (Cl-) -Balance/Imbalance
-Pain
WEEK 6
-Diabetes
Non-Insulin Dependent Diabetes (NIDDM, Type 2, Adult Onset) Insulin Dependent Diabetes (IDDM, Type 1) - Hypoglycemia & Hypoglycemic Protocol, Capillary Blood Glucose (CBG) *sulfonylureas eg. Glyburide *biguanides eg. Metformin *thiazolidinediones (TZDs) eg. Avandia and Actos - Insulins: *Humulin R (“Regular” or “Toronto”); Humulin N (“NPH”); Humulin 30/70 -Capillary blood glucose (CBG) -Fasting Blood Sugar (FBS) -Random glucose -(dipstick) urinalysis for glucose and ketones -Glycosylated hemoglobin (HbAIc) -Balance/Imbalance -Control
WEEK 7
-Hypertension (HTN)
Diuretics:
*thiazide diuretics eg. hydrochlorothiazide (HydroDIURIL)
*potassium sparing diuretics eg. spironolactone (Aldactone)
*loop diuretic eg. furosemide (Lasix)
-Antihypertensive drugs:
*beta blockers eg. propanolol (Inderal), metoprolol (Betaloc)
*calcium channel blockers eg. amlodopine (Norvasc), diltiazem (Cardizem)
*ACE inhibitors eg. ramipril (Altace)
-Lipid-lowering agents:
-statins or HMG-CoA reductase inhibitors eg. atorvastatin (Lipitor)
-bile acid sequestrants eg. cholestyramine (Questran)
-Lifestyle challenges & choices
-Health Promotion
-Hypertension, a risk factor for other co-morbidities
-Lab
-Coping
-Control
-Transition

WEEK 8
-Coronary Artery Disease (CAD)
-Atherosclerosis -Arteriosclerosis -Angina -Myocardial Infarction (MI) -Risk Factors *Cardiovascular medications continued from Week 7 -Lab -Lipid-lowering agents: *statins or HMG-CoA reductase inhibitors eg. atorvastatin (Lipitor) *bile acid sequestrants eg. cholestyramine (Questran) *Anti-coagulants eg. ASA (Aspirin) *Anti-platelets eg. clopidrogel (Plavix) and dipyridamole (Persantine) *Nitro-glycerin (sublingual spray, sublingual, topical) *Morphine sulphate (IV) Antihypertensives: -propanolol (Inderal) -metoprolol (Betaloc) -diltiazem (Cardizem) -amlodopine (Norvasc) -ramipril (Altace) -loop diuretics eg. furosemide (Lasix) -Fear -Grieving -Control
WEEK 9 MULTIPLE CHOICE & SHORT ANSWER EXAM
WEEK 10
-Congestive Heart Failure (CHF)
-Oxygen Initiation & Maintenance, SpO2, ABG
-Oxygen titration
*inotropes: eg. Digoxin
-Digoxin toxicity
*loop diuretics: eg furosemide (Lasix)
*potassium supplements: *eg. potassium chloride (Slow-K); KCL diluted in IV
fluid
-Fluid Balance
-Lab values:
-Lytes: -Na+, K+, Cl- -RBC, Hbg, Hct -ABG WEEK 11
-Cerebrovascular Accident (CVA) or Stroke
-Risk factors for CVA
-Drug therapy for acute CVA
-Nursing standards of care for acute CVA
-Health maintenance and promotion
-Diagnostic tests
-Transition
-Coping
WEEK 12
-Deep Vein Thrombosis (DVT)
-Prophylaxis for DVT
*Low molecular weight heparin eg. enoxaparin (Lovenox); dalteparin (Fragmin)
Anticoagulant therapy:
*heparin sodium (Heparin Leo) IV therapy
*warfarin (Coumadin) therapy
-Lab values:
-International normalized ratio (INR) -Prothrombin time (APT) or PT WEEK 13 -Chronic Kidney Failure (CKF) or Chronic Renal Failure (CRF) -Diminished Renal Reserve, Renal Insufficiency, Uremia -Fluid *darbepoetin alpha (Aranesp) *ferrous sulphate *vitamin D compound (Calcitrol) *calcium carbonate *sodium bicarbonate *sodium polystyrene (Kayexalate) *calcium acetate (PhosLo) -Transition/change -Balance/imbalance ASSESSMENT-DECISION-MAKING & SAFETY OF MEDICATION
ADMINISTRATION

OVERVIEW
Professional nursing practice requires a sound knowledge base and assessment
skills leading to competent decision-making. Nurses collect client data in a
variety of ways and analysis of the data leads to judgements and decision-
making. Head-to-toe assessment results in completing a quick physical
assessment. Gordon’s Health Patterns, a Nursing model for holistic assessment,
involves completing both physical and psychosocial assessments, whereas the
Medical Model guides data collection through a body systems approach.
Obtaining a timely comprehensive systematic holistic assessment of a client in a
busy practice setting can be achieved through a blending of each of the above
assessment approaches. Guided by the Decision-making for Nursing Practice
Framework, involving multiple contextual factors, competent decision-making can
then follow.
Decision-making and safety surrounding medication administration requires the
nurse has a sound knowledge base of the classification, indications, action,
normal adult dosage range, contra-indications, precautions, and side-effects of
each drug. Safety of medication administration also involves consistently
completing the “3 Checks” and the “7 Rights” of medication administration.

ENDS IN VIEW
-Overview of Gordon’s, Head-to-Toe, and the Medical Model (body systems
approach)
-Comprehend holistic practice and the roles of the professional nurse
-Review The Decision Making Model for Nursing Practice
-Review the Pharmacology Template -Comprehend Safety in Medication Administration -Review documentation
IN PREPARTION
Read:
Lewis, Heitkemper & Dirksen, pp 2-4 “Nursing Yesterday, Today, and Tomorrow
Evidence Based Practice” inclusive, and pp 18-29
Review:
“DECISION-MAKING FOR NURSING PRACTICE FRAMEWORK (Jan 2008)
IN CLASS ACTIVITY
-Story telling
-Review course packet
-Large group discussion
-Individual documentation exercises
IN REFLECTION
Review the approach you have been using to complete client assessments. What
are the strengths of your approach and the areas for improvement? Have your
assessments been holistic? Consider the ways the DMFNP Framework guides a
holistic assessment of clients and their families.
Consider the nature of the busy practice setting and how the environment/context
may impact negatively on safety in medication administration. Ask yourself,
“What can I do to avoid making mistakes in medication administration?” Consider
your areas for improvement in knowledge and behaviours. Think of general and
specific examples where you have been distracted in the clinical setting while
administering medications. Did unsafe administration of the medications occur or
could it have occurred? Think of specific strategies you will use next time you
administer medications to avoid and/or stop distractions.
ASTHMA

OVERVIEW
Asthma is a condition of reversible bronchial airways obstruction that may be
mild to life threatening. The etiology of the condition seems to be an
inappropriate immune response triggered by numerous stressors causing
bronchospasm and inflammation in susceptible individuals. Extrinsic asthma
is associated with allergy induced asthma whereas intrinsic asthma is
associated with all other non-allergenic causes. Persons with asthma have
periods of exacerbation and remissions of their signs and symptoms of the
condition. Nurses have a professional responsibility to assess for and
recognize the salient features of the client who is experiencing asthma, determine patterns, make clinical decisions, take appropriate nursing actions based on those decisions, and evaluate client outcomes. The professional nurse has a key role in health promotion while engaging in the therapeutic nurse client relationship with an individual and his/her family experiencing asthma. ENDS IN VIEW
-Define asthma
-List the etiology of asthma for both extrinsic and intrinsic sources
-Explore delegated medical functions (medications, lab values and diagnostic
tests) and tools for monitoring status
-Comprehend medications used for treating asthma
-Utilize the DMFNP Framework in caring for a client with asthma
-Explore psychosocial care of the client/family with regard to anxiety and control -Explore the health promotion and teaching role of the nurse -Reflect on the importance of a ready “Plan of Action” for a client with asthma IN PREPARATION
Read:
Lewis, Heitkemper & Dirksen,
pp 648-668 Asthma pp 675-678 O2 Therapy, Indications for use, Methods of administration, Humidification, Combustion, O2 Toxicity, Absorption Atelectasis, Infections p 354 Respiratory System p 355-356 Alterations in Acid-Base Balance & Respiratory Acidosis, Table 16-13 (Respiratory Acidosis only) p 356 Clinical Manifestations, Blood Gas Table 16-14, p 358 Table 16-16, Table 16-17 p 667 Table 28-19 Simple Face Mask only and pp 743-744 Atrovent), pp 318-323 (Atrovent), pp 737-739 (Pulmicort & Solu-Medrol) p 319 Bronchodilation and ….(only); p 323 Ipratropium (Atrovent) (only); p 355-359 Deglin and Vallerand Consult Davis’s Drug Guide for: -albuterol (Proventil) -beclamethasone (Beclovent) NB. Consult Schedule for medications you need to know for this week Internet Resources: www.asthmacontrol.com (Asthmacontrol.com) For the Asthma Control Test (ACT), a primary care clinically validated assessment tool for both children and adults determining quality of life through detecting impairment and severity of asthma links to many Websites for bronchial asthma, asthma symptoms, triggers, adult asthma, asthma education and more www.nhlbi.nih.gov (National For clients for explanations of asthma, causes, at risk, signs and symptoms, diagnosis, treatments, prevention, living with asthma and links to other websites For clinicians for asthma treatment guidelines, education and prevention programs slide kits, monographs on pharmacotherapy and other issues relating to diagnosis and treatment of asthma (Asthma and Allergy Foundation of America) Causes, diagnosis, prevention, treatment of both allergic and nonallergic asthma, facts and figures about the disease and news on clinical trials. “Ask the allergist” features posing questions by client to an allergist by email and a hotline that clients may use to learn more about the disease Asthma information and free interactive support tools assisting clients with application of clinical information to self. A treatment options report covering the pros and cons of each treatment, side-effects, questions to ask a clinician, and access to summaries of relevant clinical studies. A tool for clinicians allowing entry of basic care parameters of a case permits accessing citations of peer-reviewed clinical literature relevant to the case with quick read summaries www.aaaai.org (American Academy of Allergy, Asthma, and Immunology) Clients and professionals benefit with information on pediatric and adult asthma including signs and symptoms, diagnostic tests, medication, treatment, and “Easy Reader Sheets” for children. For clinicians, find select articles from recent literature, treatment guidelines, “Ask the Expert” involving emailing questions about a case to an allergist, and a downloadable Asthma Action Plan form to give to clients www.acaai.org (American College of Allergy, Asthma, and Immunology) Public education on exercise induced asthma, flu shots and asthma, occupational asthma, pets, pregnancy and asthma, other topics, interactive quizzes for parents of asthmatic children ages 1-8 and 8-14 in English and Spanish IN CLASS ACTIVITY
-Large group discussion
-Demonstration
-Small group work
-Simulation Lab experience
-Debrief
-Quiz
-Health Promotion/Teaching
REFLECTION
Consider the Simulation Lab experience. What did you do well in providing care?
What are your areas for improvement? What learning strategies will you put in
place to meet the ends in view?
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
OVERVIEW
Chronic obstructive pulmonary disease (COPD) defines itself in the name given
it. Chronic refers to the condition being irreversible and obstructive refers to the
generalized nature of the airways that have developed increased resistance to
airflow on forced expiration. The term COPD refers to a condition rather than to a
distinct disease process although chronic bronchitis, emphysema, small airways
anomalies or a combination of any of these conditions comprise COPD. The
pathophysiology of COPD involves narrowing or closure of the airways or major
collapses of the airways due to forced expiration, inflammation and mucus
production. Morbidity and mortality rates for the condition are high.
Nurses have a professional responsibility to assess for and recognize the salient
features of the client who is experiencing COPD, determine patterns, make clinical decisions, take appropriate nursing actions based on those decisions, and evaluate client outcomes.
ENDS IN VIEW
-Define COPD, chronic bronchitis, and emphysema
-Explore delegated medical functions and tools for monitoring status
-Utilize the DMFNP Framework in caring for a client with COPD
-Comprehend medications used for treating COPD
-Explore psychosocial care of the client/family with regard to dependency and
control
-Explore the supportive and teaching roles of the nurse relative to a client with
COPD
IN PREPARATION
Read:
-Lewis, Heitkemper & Dirksen
Oxygen Therapy, Indications for use, Methods of Administration, Combustion, CO2 narcosis, Table 28-19 Nasal cannula only; Infection, Chronic O2 therapy at home pp pp 355-356 Alterations in Acid-Base Balance & Respiratory Acidosis, Table 16-13 (Respiratory Acidosis) only, p 356 Clinical Manifestations, Blood Gas Values, Table 16-14 (Respiratory only), p 358 Table 16-16, Table 16-17 p 667 “What is your asthma control zone?” p 1164 Box 36-3 Respiratory Acidosis only NB. Consult Schedule for medications you need to know for this week

IN CLASS ACTIVITIES
-Large group discussion
-Demonstration
-Small group work
-Simulation Lab experience -Debrief -Quiz -Health Promotion/Teaching

IN REFLECTION
Consider the Simulation Lab experience. What did you do well in providing care?
What are your areas for improvement? What learning strategies will you put in
place to meet the ends in view?
PNEUMONIA
OVERVIEW
Pneumonia is a serious acute health challenge involving inflammation of all or
part of the lungs or it may be isolated solely to the bronchial area. The etiology or
cause of pneumonia varies, with many cases caused by bacterial infection,
however the pathophysiology is relatively consistent. Nurses have a professional
responsibility to assess for and recognize the salient features of the client who is
experiencing pneumonia, determine patterns, make clinical decisions, take
appropriate nursing actions based on those decisions, and evaluate client
outcomes.
ENDS IN VIEW
-Define pneumonia
-Explore delegated medical functions and tools for monitoring status
-Comprehend medications used for treating pneumonia
-Utilize the DMFNP Framework in caring for a client/family with pneumonia
-Explore psychosocial care of the client/family with regard to balance/imbalance
and pain
-Comprehend the instrumental role of the professional nurse relative to a client
with
pneumonia
-Reflect on ethical issues or concerns in the clinical setting relative to chronically
ill clients with multiple co-morbidities who are experiencing pneumonia.
IN PREPARATION
Read:
forMethods of administration, Humidification, Combustion, O2 toxicity, Absorption atelectasis, Infection inclusive pp 358-362 Oral Fluid Replacement – Review Questions inclusive -Brophy, Scarlett-Fergusion & Webber pp 85-92 opioids, pp 486-490 penicillins, pp 490-493 cephalosporins, pp 504-507 aminoglycosides, pp 535-536 vancomycin
-Deglin & Vallerand ceftriaxone (Rocephin) – know classification, contra-
indications, and signs and symptoms of allergic reaction
NB. Consult Schedule for medications you need to know for this week
IN CLASS ACTIVITY
-Small group work
-Simulation Lab experience
-Quiz
-Discussion
IN REFLECTION
Consider safety measures you have learned relative to professional nursing
practice and providing care for a client who is experiencing pneumonia. How will
you remember to incorporate these safety measures into your practice?
What do you need to know more about? How will you address your learning
needs?
Consider your own beliefs and values relative to an elderly client with multiple
chronic co-morbidities who has pneumonia and a mutually agreed upon
Physician’s order for “Comfort measures only”, no aggressive treatment.

DIABETES MELLITUS (NIDDM & IDDM)

OVERVIEW
Diabetes mellitus is an increasingly common disorder related to the inability of
the body to metabolize carbohydrates (glucose) due to dysfunctions in the insulin
mechanism. The three main insulin mechanism dysfuntions in the body include
the pancreas not producing enough insulin, deactivation and decreased
effectiveness of insulin, and the cells requiring more insulin for functioning. These dysfunctions may occur alone or operate together. Inability to metabolize carbohydrates (glucose) quickly leads to disorders in protein and fat metabolism. Untreated, uncontrolled diabetes may result in multisystem disease including
hypertension, heart disease, coronary artery disease, stroke, and renal
disease. Blindness and lower leg amputations are also common. Health
promotion and support are key factors in assisting clients with diabetes. In the
clinical setting, nurses have a professional responsibility to assess for and
recognize the salient features of the client who is experiencing diabetes,
determine patterns, make clinical decisions, take appropriate nursing actions
based on those decisions, and evaluate client outcomes.

ENDS IN VIEW
-Define Non-Insulin Dependent Diabetes (NIDDM)
-Define Insulin Dependent Diabetes (IDDM)
-List risk factors associated with diabetes
-Explore delegated medical functions and tools for monitoring status
-Utilize the DMFNP Framework for caring for a client with diabetes
-Explore psychosocial care of the client/family with regard to balance/imbalance
and control
-Explore the health promotion/teaching role and the supportive role of the nurse
relative to self-care for the client/family with diabetes
IN PREPARATION
Read:
-Lewis, Heitkemper & Dirksen
pp 1276-1299 Diabetes Mellitus – Acute -Brophy, Scarlett-Ferguson & Webber pp 427-434 Type 1 Diabetes – Focus on insulin, sulfonylureas (Metformin) Humulin R, Humulin N, Humulin 30/70; pp 407-41 Metformin (biguanide family p 415), Glyburide (sulfonylurea family) pp 413-415, Actos and Avandia (thiazalidines family); pp 407-408 Hypoglycemic drugs – insulin pp 409-411 Table 26.1 (insulins) focus on Humulin R, Humulin N, and Humulin 30/70 NB. Consult Schedule for medications you need to know for this week IN CLASS ACTIVITY
-Individual Exercises
-Small group work (Case-studies)
-Large group discussion
-Visual Media
-Quiz

IN REFLECTION
Consider the various clinical scenarios from the case-studies. Was your
knowledge base satisfactory for completing comprehensive safe assessments?
Were you able to enact appropriate nursing standards of care? If not, what
information do you need to review and learn? Reflect on the in-class research
article and visual media. List important areas for client learning and strategies
you could use in teaching.
HYPERTENSION (HTN)
OVERVIEW
Hypertension refers to sustained greater than average force, pressure, or tension
of blood being exerted on the arterial vessel walls. The elevation in BP may
occur in either or both systole and diastole. The blood pressure readings must be
elevated above average range on at least three consecutive occasions, over
several weeks, for a conclusive diagnosis of hypertension. Primary hypertension
is also called essential hypertension and exists without any identifiable etiology
though contributing factors have been identified in research studies. Secondary
hypertension occurs in response to an underlying health challenge. In secondary
hypertension, the BP returns to normal range once the health challenge has
been corrected. Hypertension is associated with high morbidity and mortality
rates. Uncontrolled hypertension may lead to atherosclerosis, arteriosclerosis,
myocardial infarction, stroke and chronic kidney disease. Ironically, hypertension
does not cause noticeable signs and symptoms until severe damage has already
resulted in the body and is, therefore, called the “silent killer”. Nurses have a
professional responsibility to assess for and recognize the salient features of the
client who is experiencing hypertension, determine patterns, make clinical
decisions, take appropriate nursing actions based on those decisions, and
evaluate client outcomes.

ENDS IN VIEW
-Define hypertension
-List factors contributing to the development of primary (essential) hypertension
-Utilize the DMFNP Framework for caring for a client with HTN
-Explore delegated medical functions and tools for monitoring status
-Comprehend medications used in treating HTN
-Explore the teaching role and the supportive role of the nurse relative to a client
with HTN
-Explore psychosocial care of the client/family with regard to coping, control, and transition -Utilize select principles of teaching and learning relative to a client with HTN

IN PREPARATION
Read:
-Brophy, Scarlett-Ferguson & Webber pp 805-808 Thiazide Diuretics: hydrochlorothiazide (HydroDiuril) Potassium Sparing Diuretics: spironolactone (Aldactone) Anti-hypertensives: pp 872 beta blockers – propanolol (Inderal) p 873 calcium channel blockers – diltiazem (Cardizem) & amlodopine (Norvasc) pp 785 Antihypertensives: Classifications & Individual Drugs, Angiotensin-Converting Enzyme Inhibitors, & Captopril; pp 786-788 Table 48.1 pp 835-849 Lipid lowering agents: Statins: atorvastatin (Lipitor); bile acid sequestrants; cholestyramine (Questran); fibrates: gemfibrozil (Lopid), and niacin NB. Consult Schedule for medications you need to know for this week IN CLASS ACTIVITIES
-Large group activity
-Small group activities
-Case studies
-Quiz

IN REFLECTION
Consider clients you have cared for with HTN. Did any of the clients know the
risk factors for HTN? Did they know of lifestyle changes that could alleviate or
reduce their HTN? Were they willing or able to make the necessary changes?
Why or why not?

CORONARY ARTERY DISEASE (CAD)

OVERVIEW
Coronary artery disease results from fatty plaques being deposited
(atherosclerosis) in the coronary arteries of the heart that eventually calcify,
harden and result in narrowing of the coronary arteries. Diminished blood flow,
diminished nutrients and decreased oxygen to the myocardium of the heart
directly result from the atherosclerotic/arteriosclerotic process. Arteriosclerosis is
the term used for atherosclerosis that has calcified and hardened. “Hardening of
the arteries” is a lay person’s term for Coronary Artery Disease. CAD is also
commonly called “Coronary Heart Disease (CHD)”, Arteriosclerotic Heart
Disease (ASHD), and Cardiovascular Heart Disease (CVHD). There are
numerous risk factors for the development of CAD. Along with recognizing the
salient features of the client who has CAD, determining patterns, making clinical
decisions, taking appropriate nursing actions based on those decisions and
evaluating client outcomes, the professional nurse has a significant role to play in
health promotion relative to both men and women relative to CAD.

ENDS IN VIEW
-Define CAD
-Utilize the DMFNP Framework for caring for a client with CAD
-Explore delegated medical functions and tools for monitoring status
-Comprehend medications used for treating CAD
-Comprehend the instrumental role and the supportive role of the professional
nurse relative to a client with CAD
-Explore the psychosocial care of the client/family with regard to fear, grieving,
and control
IN PREPARATION
Read:
-Lewis, Heitkemper & Dirksen,
pp 844-845 Gerontological Considerations: Coronary Artery Disease (CAD) – Women and CAD p 840 Table 33-18 Emotional and Behaviouoral Responses to Acute MI -Internet Resources: NB. Consult Schedule for medications you need to know for this week -Medications you need to know/learn: -Anticoagulant : ASA (80 mg to 325 mg per day dose) -Anti-platelets: clopidrogel (Plavix) and dipyridamole (Persantine) -Nitroglycerin as sublingual spray, as topical paste or patch eg. (Nitro-Dur) -Morphine sulphate (IV) Antihypertensives:
-propanolol (Inderal)
-metoprolol (Betaloc)
-diltiazem (Cardizem)
-amlodopine (Norvasc)
-ramipril (Altace)
-Lipid-lowering agents: statins: atorvastatin (Lipitor) and bile acid sequestrants:
cholestyramine (Questran)
-loop diuretics: furosemide (Lasix)

IN CLASS ACTIVITES
-Large group discussion
-Simulation Lab experience
-Debrief
-Individual exercises
-Small group work
-Quiz

IN REFLECTION
Consider the Simulation Lab experience. Were you confident and competent in
providing nursing care at a beginner level for a client experiencing angina and or
myocardial infarction? What contributed to being confident and competent?
Anxiety in critical acute health challenges can affect performance. What do you
need to do to overcome feelings of anxiety that you may have to enhance your
performance as a nurse?
CONGESTIVE HEART FAILURE (CHF)
OVERVIEW
Congestive heart failure (CHF) is not a disease, rather it is a condition resulting from a combination of pathological factors that eventually negatively affect the heart muscle’s ability to pump blood. Initially, despite the pathological factors, compensatory mechanisms sustain the heart’s ability to function, but eventually the heart weakens, cardiac output is reduced, blood flow to the tissues diminishes and cardiovascular (systemic) and pulmonary congestion occur. The condition is irreversible, however functional ability can be maintained to a certain degree, and for some time, with medications. Nurses have a professional responsibility to assess for and recognize the salient features of the client who is experiencing CHF, determine patterns, make clinical decisions, take appropriate nursing actions based on those decisions, and evaluate client outcomes. ENDS IN VIEW
-Define CHF
-Utilize the DMFNP Framework for caring for a client with CHF
-Explore delegated medical functions and tools for monitoring status
-Comprehend the medications used in treating CHF
-Comprehend the instrumental role and the teaching role of the nurse
-Explore psychosocial care of the client/family with regard to dependency,
coping, and grieving

IN PREPARATION
Read:
Lewis, Heitkemper & Dirksen
pp 849-864 Congestive heart failure – evaluation inclusive p 358-361 Laboratory Values – Intravenous p 1151 Table 36-3 Hyponatremia and hypokalemia only p 1154 Table 36-4 Fluid Volume Excess (FVE) p 1159-1662 Measuring Fluid Intake and Output – Laboratory Studies p 1160 Table 36-7 focus on FVE only p 1164 Box 36-3 Fluid and Electrolytes p 1167-1170 Health Promotion-Restriction of Fluids inclusive p 1170 Administration of IV Therapy only p 1171 Table 36-8 hypotonic only Brophy, Scarlett-Ferguson, & Webber P 821 Box 50.1 focus on ACE Inhibitors, Beta-Adrenergic Blocking Agents, Diuretics, Aldosterone Antagonist – Digoixin Toxicity inclusive pp 515-517 Factors influencing Loss & Grief IN CLASS ACTIVITY
-Individual exercises
-Case studies
-Small group work
-Quiz
IN REFLECTION
Consider clients you have nursed with CHF with differing cultural backgrounds.
What role did family play in providing support for the client? What roles of the
nurse were required in providing care to the client/family?
CEREBROVASCULAR ACCIDENT (CVA)

OVERVIEW
Familial tendencies (genetics and lifestyle) predispose to the development of
fatty plagues being deposited (atherosclerosis) in the vascular system that
eventually harden and calcify (arteriosclerosis) resulting in narrowing of the
arteries. The entire cardiovascular system and the target organs that are
nourished by the cardiovascular system are affected, however, the target organ
of concern, here, is the brain.
The diseased vessels of the brain are susceptible to thrombus formation, emboli,
cerebral aneurysms and intracranial hemorrhage or subarachnoid hemorrhage.
Diminished blood flow to the brain or in the brain results in ischemia and the
bursting of a diseased vessel results in hemorrhage. The event is known as a
Cerebrovascular Accident (CVA), or stroke, with the resulting necrosis or infarct
of the brain tissue manifesting in neurological deficits associated with the
affected area.
ENDS IN VIEW
-Define CVA
-List the risk factors associated with CVA archived
-Explore the delegated medical functions and tools for monitoring status
-Utilize the DMFNP Framework for caring for a client with a CVA
-Explore the instrumental, supportive and educative roles of the professional
nurse relative to a client/family with a CVA
-Explore psychosocial care of the client/family with regard to transition and
coping

IN PREPARATION
Read:
-Lewis, Heitkemper & Dirksen,
-Deglin & Vallerand “Davis’s Drug Guide
Brophy, Scarlett-Ferguson, & Webber p 894 eg. dipyridamole
IN CLASS ACTIVITY
-Role play
-Large group discussion
-Small group work
-Individual exercise
-Quiz

IN RELFECTION
Consider quality of life versus quantity of life issues and concerns for
clients/families experiencing a stroke.

DEEP VEIN THROMBOSIS (DVT)
OVERVIEW
Deep vein thrombosis is an acute health challenge that is also known as
“thrombophlebitis”. The deep rather than the superficial veins of the iliac,
femoral, or popliteal areas may be affected, but the focus of our exploration is
deep vein thrombosis of the calf. Deep vein thrombosis has multiple etiologies.
In deep vein thrombosis of the calf, thrombus formation and inflammation are
both present, however, the only symptom that may be present is tenderness. The
nurse has a professional responsibility to recognize risk factors contributing to DVT, recognize the salient features of the client experiencing DVT, determine patterns, make clinical decisions, take appropriate nursing actions based on those decisions, and evaluate client outcomes.

ENDS IN VIEW
-Define DVT (deep vein thrombosis)
-List risk factors for developing DVT
-Explore delegated medical functions and tools for monitoring status
-Utilize the DMFNP Framework for caring for a client with a DVT
-Explore the teaching role of the nurse for a client with a DVT
IN PREPARATION
Read:
-Lewis, Heitkemper & Dirksen
pp 935-943 Deep Vein Thrombosis - Evaluation -Brophy, Scarlett-Ferguson & Webber pp 888-890 Anticoagulants – Table 54.2 focus on: -heparin (Heparin Leo); -dalteparin (Fragmin); -enoxaparin (Lovenox) Deglin & Vallerand “Davis’s Drug
IN CLASS ACTIVITY
-Story-telling
-Large group discussion
-Small group work
-Case-studies

CHRONIC KIDNEY DISEASE (CKD)

OVERVIEW
Chronic kidney disease, formerly known as chronic renal failure (not to be
confused with acute renal failure) is an irreversible dysfunctional condition of the
kidneys. Multiple etiology can contribute to the condition characterized by
insufficient excretion and impaired regulatory function. Classification of Chronic Kidney Disease is done in five stages from kidney damage to End-stage renal disease (kidney failure). Kidney failure can also be grouped in three classifications including diminished renal reserve, renal insufficiency (failure), and uremia, also known as End-Stage Renal Disease (ESRD). In the stage of diminished renal reserve, significant renal function of the kidney tissue and nephrons have been lost, but mechanisms of homeostasis act to preserve kidney function. In the stage of renal insufficiency (failure), serum nitrogen and serum creatinine levels are elevated indicating the retention of nitrogenous waste products. The stage of uremia results from progressive demise in excretion and regulatory function of the kidneys where nitrogenous waste products further increase, fluid and electrolyte disturbances occur with every body system involved, and systemic defining characteristics present. Nurses have a professional responsibility to recognize the salient features of the client experiencing CKD, determine patterns, make clinical decisions, take
appropriate nursing actions based on those decisions and evaluate client
outcomes. The teaching role and counseling role of the professional nurse are of
high priority in working with a client with CKD.
ENDS IN VIEW
-Define chronic kidney disease
-Define end-stage-renal failure
-Recognize the five stages, and the three classifications of chronic kidney
disease
-Explore delegated medical functions and tools for monitoring status
-Utilize the DMFNP Framework in caring for a client with end stage kidney
disease
-Explore the supportive and teaching role of the nurse for client/family with
chronic kidney disease
-Explore psychosocial care of the client with regard to transition,
balance/imbalance, coping and grieving
IN PREPARATION
Read:
-Lewis, Heitkemper & Dirksen
pp 1217 pp 1224-1243 Chronic Kidney disease-Effectiveness of and adaptation of Hemodialysis inclusive pp 1245-1252 Kidney transplantation – Review Questions inclusive -hyperphosphatemia -hypermagnesemia Brophy, Scarlett-Ferguson & Webber Deglin & Vallerand “Davis’s Drug Guide -sodium polystyrene sulfonate (Kayexalate) -review beta blockers, ACE inhibitors & calcium channel blockers
IN CLASS ACTIVITY
-Computer Lab
-Large group discussion
-Case-study
- Quiz
Internet Resources:
Web: www.kidney.org/professionals/kdoqi/guidelines.cfm
The website above has links to general and specific guidelines for the care of
clients with Chronic Kidney Disease (from the Kidney Disease Outcomes Quality
Initiative (National Kidney Foundation)
www.kidney.org/professionals/kdoqi/guidelines_ckd/toc.htm (Clinical Practice
Guidelines for Chronic Kidney Disease: Evaluation, Classification, and
Stratification (2002))
www.kidney.org/professionals/kdoqi/guidelines_bp/index.htm (Clinical Practice
Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney
Disease (2004))
www.kidney.org.professionals/kdoqi/guideline_diabetic/pdf/Diabetes_AJKD_linked.pdf (Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease (2007)) www.kidney.org/professionals/kdoqi/guidelines_anemia/index.htm (Clinical Practice guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease (2006)) www.kidney.org/professionals/kdoqi/guidelines_bone/index.htm (Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic www.kidney.org/professionals/kdoqi’guidelines_lipids/index.htm (Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease (2003)) The following pertain to clients on dialysis: www.kidney.org/professionals/kdoqi/guideline_upHD-PD_VA/index.htm Hemodialysis Adequacy, Peritoneal Dialysis Adequacy, and Vascular Access Update (2006) www.kidney.org/professionals/kdoqi/guidelines_cvd/index.htm Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients (2005) www.kidney.org/professionals/kdoqi/guidelines_updates/doqi_uptoc.html#an Clinical Practice Guidelines for Anemia of Chronic Renal Failure (2001) www.kidney.org/professionals/kdoqi/guidelines_updates/doqi_nut.html Nutrition in Chronic Renal Failure (2000) IN REFLECTION
Consider the client with CKD and his/her request to not have further medical
treatment. What are your beliefs and values on “refusal of treatment?” What is
your role as a nurse in this situation?

Source: http://www2.langara.bc.ca/programs-courses/course-outlines/university-career/200830/NURS_2140_002_Stunder_200830.pdf

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